Healthcare Provider Details

I. General information

NPI: 1265079545
Provider Name (Legal Business Name): COMMUNITY MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 01/31/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 23 1/2 ROAD SUITE 301
GRAND JCT CO
81505-8904
US

IV. Provider business mailing address

PO BOX 1727
GRAND JUNCTION CO
81502-1727
US

V. Phone/Fax

Practice location:
  • Phone: 970-644-4030
  • Fax: 970-644-3914
Mailing address:
  • Phone: 970-644-4030
  • Fax: 970-644-3914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN THOMAS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 970-644-3011